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Botox For Treating Foot Deformity

The most prevalent musculoskeletal disorder in kids with cerebral palsy is foot deformity. The equinus foot deformity is the most common. Children with cerebral palsy, especially the hemiplegic type, often have spastic equinovarus feet, which are characterized by restricted ankle dorsiflexion and forefoot inversion.   

Equinus is a common foot deformity in patients with spastic cerebral palsy, with a prevalence of 83.3%. Concerning issues include foot pain, toe walking, gait instability, plantar fasciitis, walking intolerance, impaired oxygen uptake rate, and inability to walk long distances.

In ambulatory children with cerebral palsy, dynamic foot abnormalities can cause inadequate initial heel contact, which can lead to instability in the stance phase or poor foot clearance in the swing phase. Equinus foot usually causes stiff, spastic muscles. In severe cases, children might be unable to control their movements or walk. Additionally, improper foot pressure distribution when walking might cause callus formation and localized pain. 

Botox Injections for Managing Equinus Foot 

Botulinum toxin type A (BoNT-A) injection for spastic muscles has been widely used in children with spastic cerebral palsy over the last decade. Recent systematic reviews have recommended BoNT-A injection as a treatment option for children with cerebral palsy who have dynamic equinus feet.

In several studies, Botox has been shown to relax spastic muscles, enhance balance, and walking ability, and resolve foot deformity (according to Koman 1993; Calderon-Gonzalez 1994; Koman 1994). Botox could also help avoid undergoing orthopedic surgery (Metaxiotis 2002).

Koman et al. investigated the effect of Botulinum toxin in twelve ambulatory children with CP and dynamic equinus contracture in a randomized, double-blind control study. They used a physician rating scale, observational gait analysis, and a guardian/parental observation to assess gait and function. When compared to the placebo group, the children who received Botulinum toxin had a substantial improvement in their gait pattern.

Improves Gait and Function 

Botox has been widely used to treat spastic equinus foot deformity. In different studies, the types of Botox, dosage, injection sites, and use of adjunct interventions (physiotherapy, casting) vary significantly. Evidence reinforces the use of Botox to correct spastic equinus deformity in children with CP. It has been proven to improve gait and possibly function.

Static foot pressure analysis has been used as a clinical tool in children with cerebral palsy to assess changes in the foot contact pattern in a standing position after Botox injection for dynamic equinus. However, a static technique might not adequately evaluate dynamic foot deformity that occurs while walking. 

Dynamic foot pressure measurement using a computerized insole sensory system is widely accepted as a reliable method for evaluating dynamic changes in foot pressure distribution while walking. Thus, measurements of dynamic foot pressure in children with cerebral palsy have been obtained successfully in order to determine the pressure distribution while walking. Previous research using dynamic foot scans revealed substantial changes in foot pressure distribution following therapeutic intervention for both valgus and varus deformities.

Adjunct to Botox Injections

To enhance the beneficial effect of Botulinum toxin injections, various modalities have been utilized as an adjunct. For example, serial casting, physiotherapy and orthotics are used to enhance the effects of Botox injections.

Two randomized controlled trials looked at the effect of casting after Botulinum toxin injections in children with equinus. Bottos et al. considered five juvenile patients with spastic diplegia who received Botulinum toxin injections alone for dynamic equinus to five who received casting for three weeks after injection. At four months after treatment, the addition of casting provided a longer-lasting effect of reduced spasticity and improved function, as well as increased stride length.

Children with cerebral palsy frequently benefit from physiotherapy programs. These, however, vary greatly in terms of the modalities used and the intensity. Physiotherapy programs, such as strengthening programs, have been shown to be effective in children with cerebral palsy. All studies that looked at the effectiveness of Botox injections included physiotherapy. There is no ample equinus deformity in ambulatory children with cerebral palsy evidence to support or refute the effectiveness of physiotherapy as an adjunct to Botox injections in children with cerebral palsy to improve dynamic equinus.

Most experts believe that when using Botulinum toxin injections to treat dynamic equinus deformities in children with cerebral palsy, physiotherapy should always be used. Experts agree that physiotherapy modalities such as strengthening, stretching, and targeted motor training should be used routinely as adjuncts to Botulinum toxin injections to treat dynamic equinus.

The Effects of Botox Injections 

When Botox is injected into the muscle, it prevents overactive muscles from tensing, thus reducing muscle stiffness. This allows the muscles to be stretched and encourages normal growth. Injections are needed every 3 to 6 months or when the toxin's effects wear off.

A new study shows that Botox, or Botulinum toxin, could successfully treat two types of neuropathy. Neuropathy is caused by nerve damage and can manifest as either shooting pain or loss of feeling in the child's hands and feet. The Botulinum toxin resulted in a long-term reduction of pain in the study. The study also looked into the effects of injecting Botulinum toxin B (Botox B) locally versus spinally. The Food and Drug Administration approved Botox-B for medical use.

The Side Effects of Botox Injections

Mild to moderate side effects might occur, including muscle weakness. In a large study of 114 children, there were no serious or irreversible side effects. Most of the side effects were mild (Koman 2000). You should contact your doctor if your child experiences severe side effects after Botox injections. 

Choose Your Doctor Carefully

Botox should only be used under the guidance of a physician. To prevent side effects, injections must be precisely placed. Botox therapy could be dangerous if not used correctly. Request a referral from your primary care physician, or look for a physician who specializes in treating equinus foot deformity and has prior experience with Botox treatments.

Botox injections have been proven to cause muscle weakness, which is exactly what they are supposed to do. To get the most out of Botox injections, your physician must inject the right dose into the right muscle. A qualified and certified physician can guide you on the treatment procedure and assist you in determining whether it is appropriate for your child's needs and health.

Approved Indications for Botox